BILL NUMBER: AB 775	CHAPTERED  07/14/99

	CHAPTER   124
	FILED WITH SECRETARY OF STATE   JULY 14, 1999
	APPROVED BY GOVERNOR   JULY 14, 1999
	PASSED THE ASSEMBLY   JULY 6, 1999
	PASSED THE SENATE   JULY 1, 1999
	AMENDED IN SENATE   JUNE 21, 1999
	AMENDED IN ASSEMBLY   APRIL 13, 1999
	AMENDED IN ASSEMBLY   APRIL 5, 1999

INTRODUCED BY   Assembly Member Calderon
   (Coauthor:  Senator Speier)

                        FEBRUARY 24, 1999

   An act to amend Section 4603.2 of, and to add Section 4600.4 to,
the Labor Code, relating to workers' compensation.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 775, Calderon.  Workers' compensation:  medical care.
   (1) Existing law requires an employer to provide health care to
injured employees for injuries and diseases compensable under the law
relating to workers' compensation.  Existing law requires the
Administrative Director of the Division of Workers' Compensation to
biennially adopt and revise an official medical fee schedule.
   This bill would require that a workers' compensation insurer,
third-party administrator, or other entity that requires a treating
physician to obtain either utilization review or prior authorization
in order to diagnose or treat compensable injuries or diseases ensure
the availability of those services from 9 a.m. to 5:30 p.m. Pacific
coast time of each normal business day.  The bill would define normal
business day.
   (2) Existing workers' compensation law requires an employer to
make payment for medical services rendered by an employee's treating
physician after receipt of certain required reports, and requires
that payment for medical treatment provided or authorized by the
treating physician be made by the employer within 60 days after
receipt of each separate, itemized billing, together with any
required reports.
   This bill would refer to payment for medical treatment provided or
authorized by the treating physician selected by the employee or
designated by the employer.  It would also provide that if the
billing or a portion thereof is contested , denied, or considered
incomplete, the physician shall be notified, in writing, that the
billing is contested , denied, or considered incomplete, within 30
working days after receipt of the billing by the employer.  The bill
would require a notice that a bill is incomplete to state all the
additional information required to make a decision.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:


  SECTION 1.  Section 4600.4 is added to the Labor Code, to read:
   4600.4.  (a) A workers' compensation insurer, third-party
administrator, or other entity that requires, or pursuant to
regulation requires, a treating physician to obtain either
utilization review or prior authorization in order to diagnose or
treat injuries or diseases compensable under this article, shall
ensure the availability of those services  from 9 a.m. to 5:30 p.m.
Pacific coast time of each normal business day.
   (b) For purposes of this section "normal business day" means a
business day as defined in Section 9 of the Civil Code.
  SEC. 2.  Section 4603.2 of the Labor Code is amended to read:
   4603.2.  (a) Upon selecting a physician pursuant to Section 4600,
the employee or physician shall forthwith notify the employer of the
name and address of the physician.  The physician shall submit a
report to the employer within five working days from the date of the
initial examination and shall submit periodic reports at intervals
that may be prescribed by rules and regulations adopted by the
administrative director.
   (b) Payment for medical treatment provided or authorized by the
treating physician selected by the employee or designated by the
employer shall be made by the employer within 60 days after receipt
of each separate, itemized billing, together with any required
reports.  If the billing or a portion thereof is contested, denied,
or considered incomplete, the physician shall be notified, in
writing, that the billing is contested, denied, or considered
incomplete, within 30 working days after receipt of the billing by
the employer.  A notice that a billing is incomplete shall state all
additional information required to make a decision.  Any properly
documented amount not paid within the 60-day period shall be
increased by 10 percent, together with interest at the same rate as
judgments in civil actions retroactive to the date of receipt of the
bill, unless the employer does both of the following:
   (1) Pays the uncontested amount within the 60-day period.
   (2) Advises, in the manner prescribed by the administrative
director, the physician, or another provider of the items being
contested, the reasons for contesting these items, and the remedies
available to the physician or the other provider if he or she
disagrees.  In the case of a bill which includes charges from a
hospital, outpatient surgery center, or independent diagnostic
facility, advice that a request has been made for an audit of the
bill shall satisfy the requirements of this paragraph.
   If an employer contests all or part of a billing, any amount
determined payable by the appeals board shall carry interest from the
date the amount was due until it is paid.
   An employer's liability to a physician or another provider under
this section for delayed payments shall not affect its liability to
an employee under Section 5814 or any other provision of this
division.
   (c) Any interest or increase in compensation paid by an insurer
pursuant to this section shall be treated in the same manner as an
increase in compensation under subdivision (d) of Section 4650 for
the purposes of any classification of risks and premium rates, and
any system of merit rating approved or issued pursuant to Article 2
(commencing with Section 11730) of Chapter 3 of Part 3 of Division 2
of the Insurance Code.
